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PERMITTEE NAMEIADDRESS rlncluda F'acilifr Samei1,,cafiun if lbfJerrnq <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION ?G <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No 2040-0004 <br />h11 " <br />F - FINAL HOUT1 <br />SURFACE RUNOFF TO TROUT CREEr-. <br />NOTE: Read Instructions before comoletinD this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />_ <br />. -, <br />f ; <br />' J7 <br />?• r`I <br /> MEASUREMENT , <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE f ;1 cz <br /> <br />MEASUREMENT ? <br /> PERMIT <br /> REQUIREMENT 1'v G <br /> SAMPLE <br /> MEASUREMENT ! <br /> PERMIT <br /> REQUIREMENT A";' <br /> SAMPLE <br />EM <br /> MEASUR <br />ENT <br /> PERMIT t , <br /> REQUIREMENT TY <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - 4 ,' h1iJl?l e H <br /> SAMPLE <br />A /A <br />rl /A <br /> MEASUREMENT <br /> PERMIT i# -77 -r c r, <br /> REQUIREMENT " i <br /> SAMPLE i <br />AA <br />S <br /> MEASUREMENT IrJ <br />T <br /> PERMIT . _ <br /> REQUIREMENT -; - <br />.:- F 7 <br />NAMElrITLE PRINCIPAL EXECUTIVE OFFICER I certif. under pemdtl or law Chill This &-ruent and all attachments were <br />prepared under mi dim tip.-sr ulpenishm in aerurdance with u system designed TELEPHONE DATE <br /> -` <br />_ I 1 <br />-? to -re that yunlined prrunnel prnperll, gather and csaluate the infonualim, -- - - <br />- ?' -. _ <br />- suhmilled. Haled on m% ioquin or the person or perunts wlwl manage the sistem, -- <br />- _ nr Ihnse persnms directly n -lamsible for gathering the infurmahnn. the inrormation <br /> <br /> <br />- submitted n, to the heo on m. Annwledge and belief. true, accuruir. and complete. <br /> <br />I am aware that IM•rr aS..tenlficrnt txwibes for suhmdmng fake information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />l <br /> . OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED iminding the p.n.ihilit% ,d nnr and imprisonment fur An-me sidation, NUMBER <br />OD YEAR MO DAY <br />MINV C/ Vli-mi1M I IVIN Vr MI7T •rVLM 11 V1?J (nC/CI C11(;r dll all0.1II1IC1119 flurtf) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. G`. ' Tititi i; a 4-part form.